Who's Out: It's the social register you are glad excludes you, and with Version 5 the following Disorders are being redefined.

Mental Retardation. Well, what do you know about that. Intellectual Developmental Disorder will no longer be coded mild, moderate, severe, profound by IQ range.

Autism Spectrum Disorders will be more specifically identified, over DSM-IV, including the simple, but key description: "Symptoms together limit and impair everyday functioning." Limit and impair, which means you high functioning austistic types just became less autistic. On the other hand, you might now be obsessive/compulsive, so stick with the devil you know, I say....

My favorite sentence from the APA might be that the current "criteria [for austism] were equivalent to trying to “cleave meatloaf at the joints”.

Body Dysmorphic Disorder: no longer limited to body fat or weight. This is not specified in Version IV, but apparently assumed, since Version 5 stipulates, "appearance preoccupations are not restricted to concerns with body fat or weight in an eating disorder."

Blanket Narcissism(what I call the Ass-tism Spectrum, or.. no more meds for being a general jerk). Version 5 puts the screws to narcissists just where they want them, but making it more about them. To appreciate the big change to our friend T-05, Narcissistic Personality Disorder, you can study the current diagnosis, which emphasizes a "pattern of behavior," against the proposed revision, which emphasizes the results of those patterns, to self and interpersonal relationships. Says the APA, "Impairments in the self and interpersonal domains were deemed by the Work Group to be most characteristic of personality disorders."

Gender Identity Disorder is renamed Gender Dysphoria, and for an interesting look into identity, read the Rationale for the change, which was originally proposed as "Gender Incongruence" until a consult from the World Professional Association for Transgender Health.

"disorder" has a specific clinical definition, which is,

A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual [which is] associated with present distress...[and is not] merely an expectable and culturally sanctioned response to a particular event...

In the case of Gender Dysmorphia, also note that the Sexual and Identity Disorders Workgroup stated

We also debated and discussed the merit of placing this condition in a special category apart from...psychiatric diagnoses to reflect its unusual status as a mental condition treated with cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired gender.... We chose not to make any decision between its categorization as a psychiatric or a medical condition and wished to avoid jeopardizing either insurance coverage or treatment access (Drescher, 2010). (emphasis is again mine. None else italicizes quite this much.)

Childhood Gender Identity Disorder is severely specified as a mental illness as 6 of 8 traits must now be present to classify as Gender Dysphoria in Children, where DSM-IV requires only 4 of 5 traits, and does not include the statement "clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability."

Next time you think your little mission statement task force spends too much time arguing over its acronym, you might just let them take their time.

The committee of the sad would like to tweak this language somewhat; for example "reflects an underlying psychobiological dysfunction" rather than "is a manifestation of..." That sort of thing.

So....What's In:

Obsessive-Compulsives, this is your time! Skin-Picking Disorder and Hoarding -- now rate their own entries!

Exhibitionists, you've become so diversified that we need Types for you:

Sexually Attracted to Exposing Genitals to Pubescent or Prepubescent Individuals (Generally Younger Than Age 15)
Sexually Attracted to Exposing Genitals to Physically Mature Individuals (Generally Age 15 or Older)
Equally Sexually Attracted to Exposing Genitals to Both Age Groups

You must be so proud...

Unspecified Depressive Disorder - still under review, but on the table for Version 5. In case Big Pharma can not reach you on one of the 8 other categories (including Premenstrual Dysphoria, so watch your "edginess." That's also a clinical term), they may soon have a catch-all bucket for you.

Medical codes for Agoraphobia! It's all about the coding for you and your IN'sharns company. In exchange, you must now be agoraphobic for more than 6 months, it must impair your functioning (WoW does not qualify), and you have to test out of 5 other disorders first (which is true today).

Back to Body Dysmorphia, proposed revision would include repetitive behaviors in response to the dysmorphia, which at a stretch could include cosmetic surgeries.

Dyslexia - was always in there, but called "Reading Disorder." In addition to its new name, it aligns better with IDEA regulations, which address achievement potential in people with learning disabilities, a potential DSM-IV does not recognize. And for those of us in the adaptive technologies and access game, the removal of "comprehension" as one of the reading difficulties associated with dyslexia is a major win. With the right access to the written word, people with dyslexia comprehend just fine.

As for the switch to Arabic numerals, the APA has gone digital with the rest of American Medicine -- this allows them to make point revisions like 5.2 and 5.3, which translate better than IV-TR did. Because no one could figure out what number TR was.

Tuesday, December 20, 2011

What a difference a month makes. Those of you trying to follow the veiled mill updates deserve some news, after the most recent -- because everything old is new again.

When we last checked in, some of the Readership were condemning my strategy of remaining invisible to the New Brass, and the joke's on you. Because both of these yo-yos have been voted off of our show.

In a murder-suicide, she sent Crazy packing, then followed him by about a week. And we are right back where we started from. She held a new record, in fact, for shortest term in that chair. We now choose it by lottery, if you're playing.

The Big Project I am Unqualified to Run (the B-PUR) continues to hang on without showing any signs of progress. I don't know why I chose Miss Haversham for this paragraph -- I guess because it was a Great Expectation and went all berserkers. And because a picture of Karen Ann Quinlan seemed mean.

Poor B-PUR has no idea that it was completely eclipsed by B-PICS, The Big Project I Inherited from my Co-Shirker -- who, if I ever see him again gets a kick in the throat. About B-PICS, I can say very little. My Ace in the Hole is reminding the customer that they insisted I manage it.

I have a meeting with Customer Who Wants Me Dead the week I get back. I think quite seriously about never going back. This may also be what keeps me from booking the west coast trip -- because I don't want to be stuck with it if I am no longer in the traveling-to-the-west-coast business.

Saturday, December 10, 2011

I began collecting catastrophes quite young. One of the first in the collection was the destruction of Pompeii in 79. 1900 years after it happened (that is...in MCMLXXIX, what a mouth full) my Latin project was a no-walls diorama with smoldering Vesuvius in the background, and on the road in forced perspective, Army men I had covered in tape, stick side out, rolled in sand, then spray-painted gray. Moereremortui quisunt inplateis.

Yesterday, on something of a whim, I decided to spend my day off touring "A Day in Pompeii" at the Science Museum.

There is no "good time" to visit a Science Museum if you want to avoid buses full of teenagers -- or worse, PRE-teenagers -- but I hoped that Friday afternoon this close to a holiday break might.... oh, who am I kidding. They filled the room, with their "oh my god, you guys," and their "Dude"s and giggling at statues' penises, but really, they were mostly harmless. Just loud. The poor docents tried to get them excited about "being an archeologist for a day," but all they were interested in was the gift shop and getting a Sobe.

So I turned my mind off to them, and concentrated on standing in front of the very things I had become so familiar with from every "amazing true life disaster" stories I had ever gobbled up.

This was not one of them -- though this is often the illustration you'll see when you crack a Pompeii overview. "Cave Canem," the Beware of Dog mosaic, was also not present. Nor were many of the fresco sections on exhibit of the erotic kind, which is also typical of what was uncovered (har har) in the dig, but not often exhibited. There were some there, all right, but if it wasn't on the students' worksheet, they weren't going to spend time on it. One student was overheard imitating their teacher, in a goofy doi-doi voice, "If you're going to get anything out of this, you're going to have to read things." Boys giggled, "yeh, right." which I was pleased to hear kids still say.

I have noticed recently, a recurring question of small kids to their adult keepers, which is, "Is this real?" Maybe we said that too, a little smarter than children of an earlier century who took faerie photos at face value and knew that Santa preferred Coca-Cola to milk. (I mixed those time periods - don't write letters). I think that if we asked "Is this real?" we meant, "pinch me I'm dreaming." In a world where everything can be simulated, and a small child can't read gallery notes in dim lighting, "Is this real" is an early attempt at critical thinking -- especially when faced with a writhing collection of fused skeletons, some of them smaller than you.

Stand around long enough and you'll learn that adult keepers do not read gallery notes either, as a dozen misunderstandings of what the castings are were passed along to new generations. But let me add, in their defense, that there was very little science in this science museum exhibit, and most of it was written on the wall in this museum famous for its hands-on exploration of how things work. A representation of how casts were made, and how they remain preserved would have helped make that more clear. A digital animation of the destruction played in a loop, but without any explanation of how this eruption was different from other eruptions. Most disappointing to me was the lack of detail on the dig itself -- a project with a 250 year timeline of its own.

But oh well, meet things where they are, not where they are not, and enjoy being in the presence of that which is real, and no longer a picture in a book: the tethered dog, the loose pig, Man on the Staircase, the Embracing Couple. Everyday items from antiquity are enough of a wonder, though I tend to think more about how the lot is quilt-wrapped up, inventoried, and shipped around. How an archeologist decides how a handful of bronze fittings become a reconstructed scale, or how they determined what that mother-of-pearl spoon was used for. I want footnotes. Ok, I guess I want hyperlinks. Is this real? How do we know?

Time your visit to see the OmniMax "Ring of Fire" film in the same time frame. I missed it, but hung out in the Theatre of Electricity, which is always entertaining, if not fully informative either. I could have stayed home and watched this for free.

Saturday, December 3, 2011

Mike asked, "Have you been to Wegman's? Do they have them up there?" Yes, Wegman's has infiltrated, and has an aggressive expansion plan, but right now is found in Northborough, MA only... about 10 miles from my place. This is not close enough to become my grocery store, and the finest minds on my board of directors had advised they would not go on opening weekend... or for several weekends. They also advised me not to watch The Ring alone. I don't always listen, but I had not yet been moved to visit Wegman's.

Now that I reduced my grocery buying to under 10 staple goods, that I can almost program a robot to select through a series of If/Then statements, I can't get interested in Event Shopping, such as that celebrated by Wegmans and its loyal shoppers.

This is not a review of Wegmans. I was not there long enough to form an opinion, other than "I can't breathe," and "where is the emergency stop on this ride?" It is a review of me in Wegmans.

Due to a series of unfortunate career choices, the next couple of weeks are about to be full of the least interesting area of my life, so I thought I would use today to get some other areas attended to -- namely, food, shelter, Christmas shopping. Down to Dudley (I wasn't kidding about that), then to Christmas Trees Shops in Shrewsbury for something terribly clever to put my gifts in.

Don't you just... love a bargain?

Christmas Tree Shops (always in the plural, please, and with the invisible W) on the first weekend was certainly crowded, but fairly subdued. It does no good to get to CTS "early," because the inventory changes all the time. But people do get more desperate and territorial in the 2nd and 3rd weekends, so I needed to get in and out as efficiently as possible. I had no plan at all to go to Wegmans.

I blame the sign.

The Northborough Crossing is not on Rt 9. But the sign is.
Now that's just sneaky. Or brilliant.

With a low fuel warning dinging at me, I decided to give the Market to end all Markets a try. It was all about this lamb stew I was going to try in the crockpot, the belief that they would have a better selection than my local, and the sign said it was right over there....

I am no stranger to SUPER supermarkets, or precious shopping experiences. I lived through the 80s, remember - the polished stones under the raw fish at J. Bildners, the minimalist shelving of Units, the Mass Ave Bread & Circus. So I can tell you that we have seen Wegmans before. What it is doing differently is being every grocery store that ever turned a young urbanites head all in one building.

Hurry! Hurry! Hurry! All under One Big Top ~~ the greatest grocery gimmicks on earth!

Start with a Central Market as your shell. Standing empty, they look very much like a BJs or a Home Depot.
Devote one end to being Marche. Only, New Englanders will not move as slowly as Europeans do, so it needs to be a little more self-serve cafeteria-ish... like a Roche Brothers. Be sure to have plenty of bulk bins, like Whole Foods, and quirky boutique brands like Trader Joes. Note the bright yellow "We're just the local Green Grocer" signs that feel one smiley short of Wal-Mart, and "Club priced" meats for the folks who just journeyed across the parking lot from BJs. Lots of little samples everywhere are real crowd-pleasers, even Stop and Shop knows that.

Now: cram it full of people and make the aisles too small for carriages, like we are used to at CVS. Artificially shorten the distance from door to counter, like Dunkin Donuts does, and now you are really in a place where things are HAPPENING.

How can you NOT buy out their inventory of lamb??

It really was a nice selection. It was just more than I wanted to pay. But of course, paying more than you want to is part of event grocery shopping. You work hard for the money, and why can't you have those savory cheese straws if you want them? That bread looks awesome. It's $5.99, but smell it! I was plowed between carts and jostled by couples, and overwhelmed by bread in 3 places 10 self-serve bars of one kind or another, and... really, it was a Christmas Tree aftershock, I think. In a 5 year old, we just call this a meltdown.

I lasted about 5 minutes. My car's exhaust system was still pinging and clanging when I returned to the safety of it

I'll take you there when you visit, just for something to do. We can marvel at why such a top-shelf grocery is the anchor of a shopping plaza that includes Dress Barn and Pay-Less, and how in the world it competes with BJs in the same complex. Let's go at 7am or after midnight, and not on a Saturday in December.

I found this picture while working on this post. It is not meant to be a concluding statement. I just love it.